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What Is Health Insurance?
Health insurance is a financial contract between an insurer and policyholder that covers medical expenses, preventive care, and overall health and wellness needs.Â
The high costs of medical care can leave debt, forcing people to declare bankruptcy and preventing them from getting the care they need. Health insurance is designed to reduce healthcare-related costs.
There are multiple types of health insurance plans that cover different expenses and hundreds of health insurance providers in each state.
Discovery of Add-on Benefits in Health Insurance Policies
Health insurance plans provide more than just coverage for your or someone else’s medical bills. Here are some other benefits that come with your health
Leveraging Telemedicine with Your Health Insurance
Telemedicine has a lot of potential and is becoming very popular. This is because it offers a convenient way to access health services. Here’s what
Seeking out Alternative Therapies and Insurance Benefits
Other treatments that are growing more popular in the wider view of health care are acupuncture, chiropractic care, and naturopathy. Let’s go further in-depth about
Awareness of Pre-Existing Conditions under Health Insurance
The health insurance issue is quite complicated, and pre-existing conditions just add to the muddle. Here is a deconstruction of what pre-existing conditions cover. What
Health Insurance Basics
Health insurance is designed to split the costs of medical care between customers and health insurance companies up to a specific limit. All health insurance plans are created with cost-sharing features in mind.
All health insurance plans have premiums, out-of-pocket limits, deductibles, co-payments, and coinsurance.Â
Premiums are the monthly fees you pay your insurer in exchange for health care coverage. Premiums are not the total amount you’ll pay for health care services. They only show how much you pay per month to have health insurance—the lower your premium, the higher your out-of-pocket cost, and vice-versa.
Max Out-Of-Pocket (OOP) costs are the yearly limit you’ll need to pay for health care services before your insurance starts covering your costs. Your max out-of-pocket limit is the maximum amount you will pay in a given year. Under the Affordable Care Act (ACA), the maximum OOP limit is $8,700 for individuals and $17,400 for family plans.
These limits, called the out-of-pocket limits, are an agreed price set by the company that, after being reached, the health insurance company will start to pay 100% of your medical bills.Â
Deductibles are a set amount of money you’ll need to pay for health care services, tests, and items before your insurance covers your medical costs. Once you’ve met your plan’s deductible, insurance pays for 100% of your health care costs.
Co-payments or co-pays are a fixed amount you pay for services or prescriptions. In most plans, you will have a co-pay for services even if you have met your deductible. Once you hit the OOP max, your insurance will take over your co-pays.
Coinsurance is a percentage of the cost that you pay for covered services. Typically plans have coinsurance or co-pays, and after the OOP max, you no longer pay your coinsurance percentage, and insurance takes over.
The Ten Essential Health Benefits
Health care insurance plans also need to cover the ten essential health benefits. The ACA made these ten health care services a requirement for all health insurance plans to provide. They are:
- Ambulatory patient services.
- Emergency services.
- Hospitalization for surgery, overnight stays, and other conditions.
- Pregnancy, maternity, and newborn care.
- Mental health and substance use disorder services.
- Prescription drugs.
- Rehabilitative and habilitative services and devices.
- Laboratory services.
- Preventative and wellness services.
- Pediatric services.
Who Should Purchase Health Insurance?
Anyone who doesn’t qualify for state-run health insurance programs should have a health insurance plan. The high cost of health care makes it unaffordable for the average American to cover medical bills on their own. Going without health care benefits can lead to mountains of debt, bankruptcy, and other financial problems.
How Much Does Health Insurance Cost?
Health insurance premiums depend on many factors, including the state in which you live, your employment status, and the type of plan you choose.Â
It’s essential to understand which factors can affect your premiums. This can help you know what you’ll likely pay ahead of time.Â
Some factors that affect health insurance premiums are:
State and federal laws:Â Legislation determines how much a health insurance company can charge and what health insurance must cover.
Location:Â The price you pay for health care coverage will vary from place to place. People who live in states and counties with more options and competition will pay less for coverage than in areas with fewer health care plans. Urban areas tend to pay less than rural areas.
Type of insurance: Whether you’re covered under an employer’s group plan or covered privately will factor in how much you pay.
Income level:Â If you are a lower-income citizen, you can expect to pay more for employer coverage but less through federal or state-sponsored programs.
Employer size:Â Employees at larger companies tend to pay less due to cost-sharing than those employed by smaller businesses.
Plan type:Â PPOs, HMOs, and marketplace plans can all vary widely in costs. You may receive different quotes depending on your research and what you decide is best for your health needs.
Age: Health insurance is usually cheaper for younger people. Older adults, who are prone to more health issues, will pay more for coverage.
Tobacco use: If you smoke, vape, or use tobacco, expect rates to be 50% higher than a nonsmoker.
Health insurance companies cannot consider your gender or current or past health history when determining your premiums.Â
If you have concerns, your best bet is to speak with a licensed insurance agent or an independent agency like PolicyHelper to discuss your health care needs before deciding on a plan.
Call now to speak with a licensed insurance agent at
(800) XXX-XXXX TTY 711
Secure your family’s future today. Let us guide you through your life insurance options and provide peace of mind for you and your loved ones.
Blue Cross and Blue Shield of Illinois complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.